Interventional radiology in paediatric palliative care

Abstract

Paediatric palliative care is a distinct subspecialty that offers treatment to children with many types of illness, including oncological, neurological and respiratory problems. Paediatric interventional radiologists can make a useful contribution to symptom management as part of a multidisciplinary team. Interventions for pain management include local ablation or other treatment of painful lesions, image-guided nerve blocks and the insertion of devices for the delivery of analgesic drugs. Various techniques are also available for the management of ascites, pleural effusions and other symptomatic complications of the underlying disease process.

Palliative care and pediatric surgical oncology

“…39,40 Interventional radiology can play an important role in case of terminal malignancy severe pain that does not respond to massive intravenous opioid infusions through the implantation of such systems for epidural or intrathecal infusion. 41,42 However, only a small number of children with cancer require neuraxial anesthesia to control their pain. 41,43 Collins et al 44 referred that only 4% of children dying of cancer required epidural or intrathecal infusions to control their pain.…”

“…41,42 However, only a small number of children with cancer require neuraxial anesthesia to control their pain. 41,43 Collins et al 44 referred that only 4% of children dying of cancer required epidural or intrathecal infusions to control their pain. 41 The principle is based on the percutaneous positioning of a lumbar epidural or subarachnoid catheter to deliver selected drugs in direct contact to nervous tissue allowing a 100-fold reduction of drug concentration.…”

“…41,43 Collins et al 44 referred that only 4% of children dying of cancer required epidural or intrathecal infusions to control their pain. 41 The principle is based on the percutaneous positioning of a lumbar epidural or subarachnoid catheter to deliver selected drugs in direct contact to nervous tissue allowing a 100-fold reduction of drug concentration. 45,46 Technical advancements have resulted in availability not only of IT external infusion lines to be connected to infusion pumps but also of internalized systems with subcutaneous programmable infusion pumps.…”

Palliative care: A surgical perspective

“… Fluid collection : Chronic pleural effusion, as well as refractory ascites, is a condition associated with different end‐stage pediatric cancers. If medical treatment fails, patients may benefit from different surgical options, such as peritoneovenous shunts, pleurodesis, or insertion of pleural catheters/port devices for drainage Urinary and digestive obstruction : Primary advanced abdominal tumors, as well as metastatic lesions, may cause urinary obstruction.…”

“…If medical treatment fails, patients may benefit from different surgical options, such as peritoneovenous shunts, pleurodesis, or insertion of pleural catheters/port devices for drainage. [10][11][12] • Urinary and digestive obstruction: Primary advanced abdominal tumors, as well as metastatic lesions, may cause urinary obstruction.…”